Provider Demographics
NPI:1003848961
Name:THE STOP & SHOP SUPERMARKET COMPANY, LLC
Entity Type:Organization
Organization Name:THE STOP & SHOP SUPERMARKET COMPANY, LLC
Other - Org Name:STOP AND SHOP PHARMACY #718
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT STOP & SHOP PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-341-3906
Mailing Address - Street 1:91 POINT JUDITH RD
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91 POINT JUDITH RD
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3468
Practice Address - Country:US
Practice Address - Phone:401-783-7768
Practice Address - Fax:401-782-4903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIL218332B00000X, 333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9010218Medicaid
4104080OtherOTHER ID NUMBER-COMMERCIAL NUMBER
RI0575340038Medicare NSC